Tailored expectant management in couples with unexplained infertility does not influence their experiences with the quality of fertility care.

STUDY QUESTION: Do couples who were eligible for tailored expectant management (TEM) and did not start treatment within 6 months after the fertility work-up, have different experiences with the quality of care than couples that were also eligible for TEM but started treatment right after the fertility work-up? SUMMARY ANSWER: Tailored expectant management of at least 6 months in couples with unexplained infertility is not associated with the experiences with quality of care or trust in their physician. WHAT IS KNOWN ALREADY: In couples with unexplained infertility and a good prognosis of natural conception within 1 year, expectant management for 6-12 months does not compromise ongoing birth rates and is equally as effective as starting medically assisted reproduction immediately. Therefore, TEM is recommended by various international clinical guidelines. Implementation of TEM is still not optimal because of existing barriers on both patient and professional level. An important barrier is the hesitance of professionals to counsel their patients for TEM because they fear that patients will be dissatisfied with care. However, if and how adherence to TEM actually affects the couples' experience with care is unknown. Experiences with the quality care can be measured by evaluating the patient-centredness of care and the patients' trust in their physician. STUDY DESIGN, SIZE, DURATION: This is a retrospective cross-sectional study. A survey with written questionnaires was performed among all couples who participated in the retrospective audit of guideline adherence on TEM in 25 Dutch clinics. PARTICIPANTS/MATERIALS, SETTING, METHODS: Couples were eligible to participate if they were diagnosed with unexplained infertility and had a good prognosis (>30%) of natural conception within 1 year based on the Hunault prediction model. We used patient's questionnaires to collect data on the couples' experience with the quality of care and possible confounders for their experiences other than having undergone TEM or not. Multilevel regression analyses were performed to investigate case-mix adjusted association of TEM with the patient-centredness of care (PCQ-Infertility) and the patients' trust in their physician (Wake Forest Trust Scale). MAIN RESULTS AND THE ROLE OF CHANCE: Couples who adhered to TEM experienced the quality of care on the same level as couples who were exposed to early treatment, i.e. started fertility treatment within 6 months after fertility work-up. There were no associations between adherence to TEM and the patient-centredness of care or the patients' trust in their physician. LIMITATIONS, REASONS FOR CAUTION: Because this study is retrospective, recall bias might occur. Furthermore, we were unable to measure the difference in experience with care over time. Therefore, our results have to be interpreted carefully. WIDER IMPLICATIONS OF THE FINDINGS: Prospective research on couples undergoing TEM have to be performed to provide more detailed insight in the patients' experiences with the decision making process and subsequently the expectant period. Tackling the barriers surrounding TEM, i.e. better counselling and more patient information material, could further improve patient experiences with the quality of care for couples who are advised TEM. STUDY FUNDING/COMPETING INTERESTS: Supported by Netherlands Organisation for Health Research and Development (ZonMW). ZonMW had no role in designing the study, data collection, analysis and interpretation of data or writing of the report. Competing interests: none. TRIAL REGISTRATION NUMBER: www.trialregister.nl NTR3405.

Association of interleukin-1 beta (+3954) gene polymorphism and gingival crevicular fluid levels in patients with aggressive and chronic periodontitis.

BACKGROUND AND OBJECTIVE: The immune mechanisms and genetic variations that regulate genetic expression, production and biological activity of IL-1beta, are thought to play an important role in the pathogenesis of periodontal disease. The aims of the present study were to analyse interleukin (IL)-1beta (+3954) genotype and allele frequency in both chronic and aggressive periodontitis patients, and also to investigate whether this polymorphism is associated with gingival crevicular fluid (GCF) IL-1beta levels, periodontal disease severity and clinical parameters in subjects of Turkish origin. METHODS: A total of 147 individuals were enrolled in the study including 56 aggressive periodontitis (AP), 44 chronic periodontitis (CP) patients and 47 healthy controls (C). Single nucleotide polymorphism at IL-1beta (+3954) is analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). GCF samples were analyzed for IL-1beta, using enzyme linked immunosorbent assay (ELISA). RESULTS: The distribution of genotypes and allele frequencies for IL-1beta (+3954) were similar among the groups, in spite of a trend toward a higher frequency of allele 2 in the patient groups. The genotype distribution and allele frequencies were also not different after stratification of subjects according to the clinical attachment level (CAL < 4 mm and CAL > 4mm). No differences were found between the GCF IL-1beta levels of the different genotypes. Allele 2 was associated with increased bleeding on probing (BOP) sites in chronic periodontitis patients. CONCLUSION: The results of this study do not support that genetic polymorphism in the IL-1beta (+3954) could be identified as a susceptibility or severity factor in aggressive periodontitis, in the present population. The association of allele 2 frequency and higher percentage of BOP sites in chronic periodontitis suggest that IL-1beta (+3954) potentially play a significant but not major role in the clinical outcome.

Host conservatism, host shifts and diversification across three trophic levels in two Neotropical forests.

Host-parasite systems have been models for understanding the connection between shifts in resource use and diversification. Despite theoretical expectations, ambiguity remains regarding the frequency and importance of host switches as drivers of speciation in herbivorous insects and their parasitoids. We examine phylogenetic patterns with multiple genetic markers across three trophic levels using a diverse lineage of geometrid moths (Eois), specialist braconid parasitoids (Parapanteles) and plants in the genus Piper. Host-parasite associations are mapped onto phylogenies, and levels of cospeciation are assessed. We find nonrandom patterns of host use within both the moth and wasp phylogenies. The moth-plant associations in particular are characterized by small radiations of moths associated with unique host plants in the same geographic area (i.e. closely related moths using the same host plant species). We suggest a model of diversification that emphasizes an interplay of factors including host shifts, vicariance and adaptation to intraspecific variation within hosts.

[Knowledge, attitudes and practices of healthcare providers in Togo regarding prevention of mother-to-child transmission of HIV in 2010]. / Connaissances, attitudes et pratiques des prestataires de soins en matière de prévention de la transmission du VIH de la mère à son enfant en 2010 au Togo.

OBJECTIVE: To evaluate the knowledge, attitudes and practices of health care providers (HCP) in Togo regarding prevention of mother-to-child transmission of HIV (PMTCT). METHOD: A cross-sectional study was conducted in 22 antenatal clinics with PMTCT programs from January 18 to February 6, 2010. Clinic selection was based on attendance and local factors. Data were collected through interviews conducted by 23 trained investigators. RESULTS: A total of 97 HCP were interviewed at the 27 selected clinics. Most, i.e., 76%, had received PMTCT training. In terms of knowledge, interview data revealed the following strengths: 83% of HCP identified transmission from mother to child as the main route of HIV transmission in children < 15 years; 87% asserted that HIV-infected pregnant women do not always transmit HIV to their children; 77% knew that the ELISA test was performed after 18 months: and 96% had a clear notion about feeding infants born to HIV-infected mothers. Knowledge assessment revealed the following weaknesses: 30% of HCP had never heard of polymerase chain reaction; 27% said that confidentiality about HIV status was not always necessary; and 22% were unaware that decontamination of equipment using a chlorine solution kills HIV. In addition, interview data revealed the following positive attitudes and practices: 83% of HCP were willing to continue working in a center with a PMTCT program and 87% referred women pregnant for the HIV serology. On the negative side, however, only 27% of HCP summonsed husbands whose wives tested positive for HIV. CONCLUSION: This investigation shows that the knowledge, attitudes and practices of HCP in Togo regarding PMTCT is fairly good. However, it also revealed several weaknesses that should be addressed by further training.

Allozyme diversity in endemic flowering plant species of the Juan Fernandez Archipelago, Chile: ecological and historical factors with implications for conservation.

The level and apportionment of allozyme diversity were determined for 29 endemic (and 1 native) species from the Juan Fernández Islands, Chile. Mean diversities at the species level (H(es) = 0.065) are low but comparable to those measured for other insular endemics in the Pacific. A high mean proportion (0.338) of species-level diversity resides among populations. Diversity statistics were compared for species in different ecological-life history trait categories and abundance classes. Species occurring in large populations and those present in scattered small populations have higher diversities than species occurring in one or two populations. Although not significant with the conservative statistical test employed, lower diversity was found in highly selfing species as compared to animal- or wind-pollinated species. The apportionment of genetic diversity within and among populations (G(ST) values) is not significantly different for any of the species categories. Of particular interest is the lack of difference between animal- and wind-pollinated species because previous analyses of large data sets showed higher differentiation between populations of animal- than wind-pollinated species. Historical factors, both ecological and phylogenetic in nature, can influence the level and apportionment of diversity within insular endemics, and thus ecological correlates of diversity seen in many continental species may not apply to endemics. The results have several conservation implications. The preservation of large populations or several small populations is important for conserving diversity within species because when species are reduced to one or two populations, allozyme diversity is sharply reduced. High mean G(ST) values for the species examined illustrate the need for conserving as many populations as possible, either in the wild or in the garden, to preserve maximal diversity within species. Effective conservation strategies require empirical knowledge of each species.

Immunity induced by DNA immunization with herpes simplex virus type 2 glycoproteins B and C.

The complete sequence of herpes simplex virus type 2 (HSV-2) glycoproteins B and C (gB & gC) were cloned into plasmid expression vectors and evaluated in murine and guinea pig genital HSV-2 models. Balb/c mice were immunized with either pgB-2 or pgC-2 plasmids intramuscularly (IM) or intradermally (ID). The vaccines induced HSV-2-specific neutralizing and ELISA IgG antibody, but little or no enhancement of viral clearance from the vagina was detected following intravaginal challenge. Immunization of guinea pigs with pgB-2 or pgC-2 induced ELISA IgG antibody; however, antibody titers were approximately one log(10) unit lower than that seen in HSV-2 convalescent sera. IM immunization of guinea pigs with either plasmid also did not decrease vaginal viral shedding following vaginal challenge, but the severity of the acute disease and the subsequent number of recurrent lesion days were reduced in animals immunized with pgB-2. Lastly, IM immunization of latently infected guinea pigs with a combined gB-2 and gC-2 plasmid vaccine significantly reduced the number of subsequent HSV-2 recurrences. DNA vectors expressing gB-2 or gC-2 were both immunogenic, although the gB-2 plasmid induced higher titers of antibody and significantly reduced primary and recurrent herpetic disease in the guinea pig model. These results also suggest that immunotherapy with plasmid expression vectors may be effective against recurrent genital HSV-2 disease.

Effects of DNA immunization formulated with bupivacaine in murine and guinea pig models of genital herpes simplex virus infection.

The immunogenicity and efficacy of a herpes simplex virus type 2 glycoprotein D (gD2) DNA vaccine formulated with bupivacaine was evaluated using murine and guinea pig models of genital herpes. Animals received three doses of 100 microg of gD2 plasmid or control plasmid intramuscularly prior to intravaginal challenge with HSV-2. Immunization induced HSV ELISA and neutralizing antibody in serum and ELISA antibody in the vaginal secretions of all animals evaluated. Following intravaginal HSV-2 challenge, vaginal viral replication was reduced in both models with peak reductions of greater than 99%. Immunization also decreased the number of animals developing any clinical disease (p < 0.001) and the severity of the acute disease (total lesion score 6.4 versus 0.6 in guinea pigs, p < 0.001). Further recurrent lesion days were reduced from 14.5 to 4.9 days in immunized guinea pigs (p < 0.001). DNA immunization with gD2 + bupivacaine was effective in reducing clinical disease and viral replication in both guinea pigs and mice.

Effect of imiquimod as an adjuvant for immunotherapy of genital HSV in guinea-pigs.

Imiquimod, an immunomodulator which upregulates cell-mediated immune responses, was evaluated as an adjuvant for immunotherapy of recurrent genital herpes simplex virus (HSV) infection in guinea-pigs. In two experiments at separate research centres, animals were immunized with HSV glycoprotein and either placebo, 1 or 5 days of imiquimod, or complete Freund's adjuvant, 14 and 35 days after genital HSV-2 infection. Recurrent lesion days were then evaluated from days 15-91. In both experiments, immunization with glycoprotein and imiquimod most effectively reduced recurrence compared with unimmunized controls (53-69%, p < 0.001-0.05). A peak reduction of 70-80% was observed following the second immunization. This reduction was greater than that provided by immunization with glycoprotein and complete Freund's adjuvant in these experiments or those previously reported.

Infertility associated with Eperythrozoon wenyonii infection in a bull.

A 16-month-old Charolais bull was examined because of acute onset of scrotal and hind limb edema, fever, tachycardia, tachypnea, anorexia, and lethargy. Scrotal circumference on initial examination was 48 cm. Clinicopathologic abnormalities included microcytic, normochromic anemia and numerous Eperythrozoon organisms in blood smears. Results of immunohistochemical staining of a skin biopsy specimen suggested that the edema was the result of an Arthus-type reaction. Semen quality deteriorated rapidly, and the bull was aspermic within 7 days. The bull was treated with oxytetracycline, and the anemia and edema gradually subsided. Eperythrozoon organisms were not detected in blood smears after 3 days. Six months after initial examination, results of physical examination and semen evaluation were normal. We hypothesize that scrotal edema caused failure of testicular thermoregulation, resulting in transient production of abnormal sperm and infertility.